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<title>慕主先鋒教會</title>
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<body>
<form action="test1.php" method="post">
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  <h1><img src="frmmtitlePic.jpg" width="785" height="75"></h1>
   
  <div id="thick-colnew"> 
  <h1>2009 夏令會報名</h1>
    
  <p>中文姓名: 
    <input type="text" name="cname">
    <font color="#FF0000">*First Name:</font> 
    <input type="text" name="firstname">
    <font color="#FF0000">*Last Name:</font> 
    <input type="text" name="lastname">
    <br>
    <font color="#FF0000">*email:</font> 
    <input name="email" type="text" id="email">
    <font color="#FF0000">*Password:</font> 
    <input type="password" name="password">
    電話(Phone): 
    <input type="text" name="home_phone">
    <br>
    <br>
    住址 (Address): 
    <input type="text" name="address1">
    城市 (City): 
    <input type="text" name="city">
    州 (State): 
    <select name="state" id="state">
      <option value="C1" selected>Northern California</option>
      <option value="C2">Southern California</option>
      <option value="AZ">Arizona</option>
    </select>
    <br>
    郵遞編號(Zip Code): 
    <input type="text" name="zipcode">
    <font color="#FF0000">*國家 (Country): </font> 
    <select name="country" id="country">
      <option value="USA" selected>USA</option>
    </select>
    <br>
    教會 (Church): 
    <input name="church" type="text" id="church">
    教會名字 (Other, Name of your church): 
    <input type="text" name="other_church">
  </p>
    
  <table class="frmm1" width="820" height="204" border="1">
    <tr> 
      <th width="4%">&nbsp;</th>
      <th width="9%" ><font size="3">中文姓名</font></th>
      <th width="16%" >英文名First Name</th>
	  <th width="32%" align="left" >英文姓 Last Name&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;性別(Gender)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</th>
      <th width="39%" align="left" >關係 Relationship &nbsp;&nbsp;&nbsp;&nbsp;組別 Group</th>

    </tr>
    <tr> 
      <td align="left" valign="top">1.</td>
      <td align="left" valign="top"><input name="cname1[]" type="text" id="cname1[]" size=5></td>
      <td align="left" valign="top">
<input name="firstname1[]" type="text" id="firstname1[]" size=15 maxlength="25"> 
      <td valign="top"><input name="lastname1[]" type="text" id="lastname1[]" size=15 maxlength="25">&nbsp;&nbsp;&nbsp;&nbsp;
        <select name="gender1[]" id="select34">
          <option value="M" selected>男-M</option>
          <option value="F">女-F</option>
        </select>
        <br>
      </td>
      <td align="left" valign="top"><select name="relationship1[]" id="relationship1[]">
          <option value="1" selected>自己(Self)</option>
          <option value="2">配偶(Spouse)</option>
          <option value="3">兒子(Son)</option>
          <option value="4">女兒(Daughter)</option>
          <option value="5">親屬(Relative)</option>
        </select>
        &nbsp;&nbsp;&nbsp;&nbsp;
		<select name="group1[]" id="select30">
          <option value="18" selected>國語大堂 Main Hall</option>
          <option value="15">English: young adult</option>
          <option value="14">English: College</option>
          <option value="13">English: grade 12</option>
          <option value="12">English: grade 11</option>
          <option value="11">English: grade 10</option>
          <option value="10">English: grade 9</option>
          <option value="9">English: grade 8</option>
          <option value="8">English: grade 7</option>
          <option value="7">Elementary: grade 6</option>
          <option value="6">Elementary: grade 5</option>
          <option value="5">Elementary: grade 4</option>
          <option value="5">Elementary: grade 3</option>
          <option value="4">Elementary: grade 2</option>
          <option value="3">Elementary: grade 1</option>
          <option value="2">Preschool</option>
          <option value="1">2-4 years</option>
          <option value="0">0-2 years</option>
        </select></td>
    </tr>


<tr>
<th></th>
<th></th>
      <th>Special Need</th>      
<th>餐數 Meal</th>
      <th>參加堂數 Section to Attend</th>

</tr>
<tr>
<td height="103"></td>
<td bgcolor="#FFCC99"></td>
      <td align="left" valign="top" bgcolor="#FFFFFF">
<select name="spneed[]" id="select33">
          <option value="1" selected>自己(Self)</option>
          <option value="2">配偶(Spouse)</option>
          <option value="3">兒子(Son)</option>
          <option value="4">女兒(Daughter)</option>
          <option value="5">親屬(Relative)</option>
        </select></td>    
      <td align="left" valign="top">
	  <table class="frmm2">
          <tbody>
            <tr align="center" valign="top"> 
              <td bgcolor="#0066CC"><font size="-5">日期 Date</font></td>
              <td><font size="-5">7/2</font></td>
              <td><font size="-5">7/3</font></td>
              <td><font size="-5">7/4</font></td>
              <td><font size="-5">7/5</font></td>
              <td><font size="-5">7/6</font></td>
            </tr>
            <tr align="center" valign="top"> 
              <td><font size="-5">午餐 Lunch </font></td>
              <td><font size="-5">N/A</font></td>
              <td><font size="-5"> 
                <select size="1" name="meal0[]" id="select25"  onChange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="meal0[]" id="select2"  onchange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="meal0[]" id="select3"  onchange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="meal0[]" id="select4"  onchange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
            </tr>
            <tr align="center" valign="top"> 
              <td height="35"><font size="-5">晚餐 Dinner </font></td>
              <td><font size="-5"> 
                <select size="1"  name="meal0[]" id="select23"  onChange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="meal0[]" id="select6"  onchange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="meal0[]" id="select7"  onchange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="meal0[]" id="select8"  onchange="" >
                  <option value="0" selected>0</option>
                  <option value="1">1</option>
                </select>
                </font></td>
              <td><font size="-5">N/A</font></td>
            </tr>
          </tbody>
        </table></td>
      <td valign="top">
	  <table class="frmm2">
          <tbody>
            <tr align="center" valign="top"> 
              <td><font size="-5">日期 Date</font></td>
              <td><font size="-5">7/2</font></td>
              <td><font size="-5">7/3</font></td>
              <td><font size="-5">7/4</font></td>
              <td><font size="-5">7/5</font></td>
              <td><font size="-5">7/6</font></td>
            </tr>
            <tr align="center" valign="top"> 
              <td><font size="-5">早上Morning</font></td>
              <td><font size="-5">N/A</font></td>
              <td><font size="-5"> 
                <select size="1"  name="section0[]" >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                &nbsp; </font></td>
              <td><font size="-5"> 
                <select size="1"  name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                &nbsp;</font></td>
              <td><font size="-5"> 
                <select size="1"  name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                &nbsp;</font></td>
              <td><font size="-5" >&nbsp; 
                <select size="1"  name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                </font></td>
            </tr>
            <tr align="center" valign="top"> 
              <td><font size="-5" >下午Afternoon</font></td>
              <td><font size="-5" > N/A</font></td>
              <td><font size="-5">&nbsp; 
                <select size="1" name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                &nbsp;</font></td>
              <td><font size="-5"> 
                <select size="1"  name="section0[]" >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                &nbsp;</font></td>
              <td><font size="-5">N/A</font></td>
            </tr>
            <tr align="center" valign="top"> 
              <td><font size="-5">晚上Evening</font></td>
              <td><font size="-5">&nbsp; 
                <select size="1"   name="section0[]" >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                </font></td>
              <td><font size="-5">&nbsp; 
                <select size="1" name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                </font></td>
              <td><font size="-5"> 
                <select size="1" name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                &nbsp; </font></td>
              <td><font size="-5"> 
                <select size="1" name="section0[]"  >
                  <option value="1" selected>Y</option>
                  <option value="0">N</option>
                </select>
                &nbsp; </font></td>
              <td><font size="-5">N/A</font></td>
            </tr>
          </tbody>
        </table></td>

    </tr>

  </table>
<p>
  <input type="hidden" name="conferenceID" value="2009Summer">
  <input type="submit" name="Submit" value="Submit">
</p>
	</form>
     <p><br>
    </p>
    <br>
    <br>
</div>
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